Abstract
Background and aim
Evidence-based prescribing practices for stroke-preventive medication have benefited stroke survivors; however, medication-nonadherence rates remain high. Medication understanding and use self-efficacy (MUSE) has shown great importance in medication-taking behavior, but its relationship with medication nonadherence in stroke-preventive regimens lacks exploration. The aim of this study was to determine the prevalence of MUSE and its association with nonadherence causes and other potential factors among stroke survivors in Malaysia.
Methods
This cross-sectional study was conducted among 282 stroke patients who provided informed consent and were in follow-up at the Neurology Outpatient Department of Hospital Kuala Lumpur, Malaysia. The study employed a data-collection form that gathered information on sociodemographics, clinical treatment, outcome measures on MUSE, and medication-nonadherence reasons.
Results
The prevalence of poor medication understanding and use self-efficacy among stroke patients was 46.5%, of which 29.1% had poor “learning about medication” self-efficacy, while 36.2% lacked self-efficacy in taking medication. Beliefs about medicine (74.02%) was the commonest reason for medication nonadherence, followed by medication-management issues (44.8%). In the multivariate model, independent variables significantly associated with MUSE were health literacy (AOR 0.2, 95% CI 0.069–0.581; P=0.003), medication-management issues (AOR 0.073, 95% CI 0.020-0.266; P<0.001), multiple-medication issues (AOR 0.28, 95% CI 0.085–0.925; P=0.037), beliefs about medicine (AOR 0.131, 95% CI 0.032–0.542; P=0.005), and forgetfulness/convenience issues (AOR 0.173, 95% CI 0.050–0.600; P=0.006).
Conclusion
The relatively poor learning about medication and medication-taking self-efficacy in this study was highly associated with health literacy and modifiable behavioral issues related to nonadherence, such as medication management, beliefs about medicine, and forgetfulness/convenience. Further research ought to explore these underlying reasons using vigorous techniques to enhance medication understanding and use self-efficacy among stroke survivors to determine cause–effect relationships.
Acknowledgments
The authors would like to thank the Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia for their financial, material, and other support. The authors wish to acknowledge the contributions of doctors, clinic nurses and patients from the Neurology Clinic, Hospital Kuala Lumpur. We are grateful to the head of the Clinical Research Centre of Hospital Kuala Lumpur and the head of the Neurology Clinic of Hospital Kuala Lumpur for their support and approval for conducting this study. We would like to thank the Director General of Health Malaysia for his permission to publish this article. This study was part of research performed by JRA in fulfillment of her PhD from Monash University.
Data-sharing statement
All data available are within the judiciary of the Director General of Health Malaysia and are the intellectual property of Monash University.
Disclosure
The authors report no conflicts of interest in this work.